
    <div id ="regFormHeader" class ="regFormHeader">
        <p align="center" style="font-size: 20px; font-weight: bold; color: blue">Fill up your information to get a New Connection</p>
    </div>
<form id="regFormBody" method="post" action="<?php echo base_url();?>register/submit" name="regFormBody">
        <fieldset id="personalFieldsCollection" class="fieldsCollection">
            <div id ="labelid" class="row" >
                <label class="label" for="name">Name</label><br/><br/>
                <label class="label" for="gendercollection">Gender</label><br/><br/><br/>
                <label class="label" for="presentAddresscollection">Present Address</label><br/><br/><br/><br/>
                <label class="label" for="permanentAddresscollection">Permanent Address</label><br/><br/><br/><br/>
                <label class="label" for="name">Father's Name</label><br/><br/>
                <label class="label" for="name">Mother's Name</label><br/><br/><br/>
                <label class="label" for="name">Email</label><br/><br/>
                <label class="label" for="name">Birthday</label><br/><br/>
                <label class="label" for="name">Already Customer</label><br/><br/>
                <label class="label" for="exchangecollection">Exchange</label><br/><br/>
                <label>&nbsp</label>
            </div>
            <div>
                
                    <input id ="firstname" class="fieldValInit" type="text"  name="firstname" title="First Name">
                    <input id ="lastname" class="fieldValInit" type="text"  name="lastname" title="Last Name">
                
                <br/><br/>
                
                <select class="fieldValInit" name="gender" id="gender" class="" title="Select Gender">
                    <option selected="" value="">- Select One -</option>
                    <option value="male" >Male</option>
                    <option value="female" >Female</option>
               </select>
                <br/><br/>
                <textarea class="fieldValInit" name="PresAdd" title="required" row="5"></textarea>
                <br/><br/>
                <textarea class="fieldValInit" name="PermAdd" title="PermanentAddress" row="5"></textarea>
                <br/><br/>
                <input id ="fathername" class="fieldValInit" type="text"  name="fathername" title="Father Name">
                <br/><br/>
                <input id ="mothername" class="fieldValInit" type="text"  name="mothername" title="Mother Name">
                <br/><br/>
                <input id ="email" class="fieldValInit" type="text"  name="email" title="Email">
                <br/><br/>
                <input id ="birthday" class="fieldValInit" type="text"  name="birthday" title="birthday">
                <br/><br/>
                <input id="iscustomer"  type="radio" name="alreadycustomer" checked="true" value="No">No
                <input id="iscustomer" type="radio" name="alreadycustomer" value="Yes">Yes
                <br/><br/>
                <select  class="fieldValInit" name="exchange" id="exchange" class="" title="exchange">
                    <option selected="" value="">- Select One -</option>
                    <?php foreach ($exchange as $e)
                    echo "<option value=$e->code title=$e->name>".$e->name.'</option>';
                    ?>
               </select>
                <br/><br/>
                <input id="submit" type="submit" value="I Accept">
            </div>
           
        </fieldset>
    </form>

